Quiz Bowl Training 1

Which of the following drugs may be associated with bradycardia? Select ALL that apply.

• amlodipine

• bisoprolol

• clonidine

• enalapril

• ivabradine

Answer explanation

Bisoprolol, clonidine, and ivabradine can cause bradycardia and/or heart block. Non-DHP CCBs also decrease AV nodal conduction and can cause bradycardia. DHP CCBs like amlodipine have no effect on AV nodal conduction, instead they can cause reflex tachycardia. ACEis like enalapril have no effect on cardiac conduction.

Which of the following drugs antagonize both B1 and B2 receptors at low doses?

• atenolol

• bisoprolol

• carvedilol

• metoprolol

• nebivolol

Answer explanation

Carvedilol is a nonselective B-blocker, antagonizing both the B1 and B2 receptors. The remaining choices are cardioselective, especially at low doses. Metoprolol also becomes non-selective at about 100 mg/day

Which of the following drugs have been shown to improve survival in patients with heart failure with reduced ejection fraction (HFrEF)? Select ALL that apply.

• carvedilol

• digoxin

• enalapril

• ivabradine

• spironolactone

Answer explanation

Ivabradine has been associated with a reduction in hospitalizations in patients with HFrEF but not with a reduction in mortality. Digoxin can reduce symptoms in HFrEF patients but has not been associated with a reduction in mortality.

Which of the following oral antithrombotic agents is/are approved for the treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE)?

• apixaban

• aspirin

• dabigatran

• rivaroxaban

• ticagrelor

Answer explanation

Antiplatelet medications like aspirin or ticagrelor would not be useful for treating DVT or PE.

Thiazide diuretics should NOT be used as a first line treatment for hypertension in patient suffering from:

• hyperlipidemia

• heart failure

• gout

• COPD

Answer explanation

Thiazide diuretics may increase the reabsorption of uric acid from renal tubules and may cause hyperuricemia. It should NOT be used as a first line treatment for hypertension in patients suffering from gout.

Which of the following is considered first-line therapy for reducing the risk of atherosclerotic cardiovascular disease (ASCVD)?

• HMG Co-A reductase inhibitors

• bile acid resins

• nicotinic acid

• fibrates

Answer explanation

ATP4 found that the use of statins for prevention of ASCVD is extensive and consistent. Statin therapy is recommended for patients at a higher risk of ASCVD who are most likely to experience a net benefit in terms of the potential for risk reduction vs the potential for adverse effects. Non-statin therapies do not provide sufficient benefits in the reduction of ASCVD risk in regards to their potential for adverse effects.

DB is a 63-year-old male who is coming into your clinic today to discuss his Coumadin therapy. He currently takes 5 mg M-F and 7.5mg on Sat/Sun for his chronic non-valvular atrial fibrillation. Recently he has noticed increased bleeding of his gums and has experienced a couple of nosebleeds which is unusual for him. His INR today is 4.6. Which of the following could be possible explanations for an increased INR while on Coumadin? Select all that apply.

• Increased dietary intake of leafy green vegetables

• Initiation of Bactrim

• Binge alcohol use

• Uncontrolled hyperthyroidism

• Missed doses

All of the following may increase triglycerides except?

• Protease inhibitor

• Bile acid sequestrants

• Fish oil

• Oral estrogens

Answer explanation

Agents that can cause elevated triglycerides: oral estrogens, glucocorticoids, bile acid sequestrants, protease inhibitors, retinoic acid, anabolic steroids, sirolimus, raloxifene, tamoxifen, beta blockers (not carvedilol), and thiazides.

A 57-year-old male patient was admitted to the hospital after exhibiting altered mental status, hypotension (BP 80/40 mmHg), and bradycardia (45 BPM). He has a history of gout, hypertension, depression, and previous myocardial infarction. The patient is reported to be taking allopurinol 100mg once daily, lisinopril 40mg once daily, sertraline 100mg once daily, chlorthalidone 25mg once daily in the morning, and metoprolol (dose and frequency unknown). It is determined that our patient is most likely suffering from beta blocker toxicity. Which of the following statements are true when it comes to beta blockers? 

• Beta blocker toxicity may be treated with adenosine

• Beta blockers are a first line treatment agent for uncomplicated hypertension as well as heart failure with reduced ejection fraction (HFrEF)

• Beta blockers can mask several symptoms of hypoglycemia

• Patients who are poor CYP2D6 metabolizers may be at increased risk of metoprolol accumulation leading to toxicity

• Atenolol, bisoprolol, nebivolol and propranolol are (β2) cardioselective 

RL is a 54yo M whose calculated 10-year atherosclerotic cardiovascular disease (ASCVD) risk is 18%. Which of the following is the most appropriate pharmacotherapy recommendation for RL?

• Rosuvastatin 10 mg PO QHS

• Atorvastatin 80 mg PO QHS

• Lovastatin 10 mg PO QHS

• Pravastatin 20 mg PO QHS

Answer explanation

This patient belongs in one of the four statin benefit groups because his estimated 10-year ASCVD risk is over 7.5%. Adults 40 to 75 years of age with LDL–C 70 to 189 mg/dL, with an estimated 10-year ASCVD risk ≥7.5% and without clinical ASCVD or diabetes should receive either a moderate-intensity or high-intensity statin. Since the extent of reducing the risk of ASCVD is proportionally related to the degree of LDL-C reduction, risk could be reduced more so with a high intensity statin. Considering the given options, Atorvastatin 80 mg PO QHS is the best choice.